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The NHS is 'fragmented and dysfunctional' says Norman Lamb MP

Former Lib Dem health minister and MP Norman Lamb outlines how integration has been a buzzword in the NHS, yet hasn't translated into services, leaving patients bereft

'Integration’ has become the buzzword of our political discourse when it comes to the NHS. The rigid divide between health and social care is constantly and profoundly exposed by a growing and ageing population. Every day we see examples of poor continuity of care, a lack of data sharing, and avoidable hospital admissions and delayed discharges caused by a dearth of community services. If we could start all over again in 1948, we would not have organised things in this way.

And yet, too often we have taken far too limited a view of integration. As well as joining up health and social care, we should also be looking at ways to better integrate primary care and secondary care services, I have always argued that our understanding of ‘integration’ should cover not only primary care and secondary care, but also mental health and physical health.

And critically, the person must always be centre-stage – what we should all be focused on is joining up care around the needs of the individual, not organisational integration.

We know that there is a close link between mental and physical health. People with severe mental illness are at risk of dying 15-20 years earlier than other people, with two-thirds of these deaths resulting from physical illnesses such as heart disease and cancer.

Despite this, the neglect of the physical health of those with mental illness, as well as the mental health needs of those with long-term physical health conditions, has been one of the most damaging institutional failures in the NHS.

The independent Mental Health Taskforce, led by Paul Farmer, recognised the urgent need for a more holistic approach to healthcare, recommending that at least 280,000 more people living with severe mental illness should have improved support for their physical health by 2020, as well as ensuring that people with long-term conditions have their physical and mental health care needs met. There is a moral imperative to sustain a cross-party commitment to deliver and build on these recommendations.

However, the complex factors that contribute to ill-health mean that integration cannot focus purely on health services. Stable employment and housing are both crucially important for maintaining good mental health and wellbeing and improving prospects of recovery for those with mental illness, but there has been a real failure to link up health services with housing and employment services.

We can make the world of difference by more effectively linking up mental health services with Job Centre Plus, investing in employment programmes such as Individual Placement and Support, and Housing First approaches which provide intensive support for getting people with mental illness or drug addictions into their own housing. Similarly, closer integration between mental health services and the criminal justice system is desperately required so that offenders with mental health needs are identified and given the appropriate support at the earliest opportunity.

It is a remarkable achievement to have designed a health system so fragmented and dysfunctional as ours. It’s time for a new approach, focused around the needs and wellbeing of the individual rather than institutions, with input from across the whole of government. Not only will this be a better use of public resources, but it will ultimately lead to a far healthier and more prosperous society.